In surgery, cystostomy is the formation of a fistulous opening and insertion into the urinary bladder and the placement of a drainage tube or a catheter into the urinary bladder through the fistulous opening. Placement of a suprapubic cystostomy tube is a common adjunct to surgery of the lower urinary tract such as prostatectomy, etc. Other than through open cystostomy, percutaneous insertion of the catheter frequently is done with a punch cystostomy kit.
A punch cystostomy kit, which also is known as a trocar, consists of a metal tube for guiding a pilot with a sharp end. The anterior abdominal wall is punched with the tube having the sharp end formed by the pilot and then the pilot is removed and replaced by a Foley catheter. Such a kit is described, e.g., in General Urology, D. R. Schmidt, II edition, 1984, pp. 141-144. The use of this kit is associated with complications including some serious complications such as placement of the catheter outside the bladder into the perivesical space or worse directly into a loop of bowel.
U.S. Pat. No. 3,640,281 issued February 1972 to Robertson describes a method and an instrument for inserting a suprapubic catheter into the bladder through the urinary tract. The instrument comprises a tube having a curved distal portion insertable through the urethra into the bladder to bring the distal end of the tube in engagement with the wall of the bladder in register with the suprapubic area of the abdominal wall. An incision is made through the abdominal wall and the wall of the bladder in register with the distal end of the instrument, which then emerges outwardly through the incision.
A disadvantage of this method is that it still requires a surgical intervention such as an incision of the anterior abdominal wall and that the incision required for this purpose has dimensions greater than those required for the insertion of the tube.
In some case, in particular, in the case of radical perineal prostatectomy, along with the insertion of a suprapubic tube it is necessary to use an instrument known as a retractor. A retractor is a surgical instrument for pulling back or retracting a prostate for placing it to the location more convenient and accessible for the operation. The retractor is usually an instrument having expandable ends which after insertion in a folded state can be unfolded to form projections perpendicular to the walls of the urinary bladder in the area of the urinary bladder neck, so that these projections can be used for moving the prostate gland and fixation thereof in the position more convenient for the operation. Thus, the perineal radical prostatectomy involves the use of two different instruments, i.e., a retractor and trocar. This makes the operation more complicated, long in time, and more susceptible to complications.
Furthermore, to reduce the risk of bowel injury, neither retractor nor trocar can be used as a device for filling the urinary bladder with a liquid or for inserting an optical fiber for viewing the operation site.